Posterior-stabilized total knee arthroplasty kinematics and joint laxity: A hybrid biomechanical study

被引:12
作者
Sekeitto, Allan R. [1 ]
McGale, Jance G. [1 ]
Montgomery, Liam A. [2 ]
Vasarhelyi, Edward M. [1 ]
Willing, Ryan [2 ]
Lanting, Brent A. [1 ]
机构
[1] London Hlth Sci Ctr, 339 Windermere Rd, London, ON N6A 5A5, Canada
[2] Univ Western Ontario, Dept Mech & Mat Engn, 1151 Richmond St N, London, ON N6A 5B9, Canada
关键词
Posterior-stabilized total knee arthroplasty (PS-TKA); Kinematics; Joint laxity; Joint motion simulator; Virtual ligament model; MEDIAL COLLATERAL LIGAMENT; CONTACT STRESS-ANALYSIS; ANTERIOR TIBIAL POST; FEMORAL ROLLBACK; HIGH-FLEXION; CRUCIATE LIGAMENT; CAM DESIGN; REPLACEMENT; OUTCOMES; MOTION;
D O I
10.1186/s42836-022-00153-4
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Background: Posterior-stabilized (PS)-total knee arthroplasty (TKA) arose as an alternative to cruciate-retaining (CR)-TKA in the 1970s. Since then, it has become a popularly utilized TKA design with outcomes comparable to CR-TKA. The post-cam mechanism is unique to PS-TKA as it substitutes the function of the posterior cruciate ligament (PCL). The study aimed to understand the kinematic and laxity changes in PS-TKA with under- and overstuffing of the tibiofemoral joint space with the polyethylene (PE) insert.Methods: This study employed a hybrid computational-experimental joint motion simulation on a VIVO 6 degrees of freedom (6-DoF) joint motion simulator (AMTI, Watertown, MA, USA). Physical prototypes of a virtually-performed TKA in mechanical alignment (MA) and kinematic alignment (KA) based on cadaveric CT scans and a virtual ligament model were utilized. The reference, understuffed (down 2 mm) and overstuffed (up 2 mm) joint spaces were simulated, neutral flexion and laxity testing loads and motions were performed for each configuration.Results: The PE insert thickness influenced post-cam engagement, which occurred after 60 degrees in the overstuffed configurations, after 60 degrees-75 degrees in the reference configurations and after 75 degrees in the understuffed configurations. The understuffed configurations, compared to the reference configurations, resulted in a mean 2.0 degrees (28%) and 2.0 degrees (31%) increase in the coronal laxity in MA and KA respectively. The overstuffed configurations, compared to the reference configuration, resulted in an increase in the mean joint compressive forces (JCFs) by 73 N (61%) and 77 N (62%) in MA and KA models, respectively.Conclusions: The under- and overstuffing in PS-TKA alter the kinematics with variable effects. Understuffing decreases the stability, JCFs and inverse with overstuffing. Subtle changes in the PE insert thickness alter the post-cam mechanics.
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页数:10
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